basic about dental implant all details r seen

DENTAL IMPLANTS
Dr. Antariksha Dod
Reader SDDCH Parbhani

INTRODUCTION
WHY IMPLANTS…
▸As Oral & Maxillo Facial Surgeons, we need to
use considerable clinical skills to help our
patients cope with the effects of partial or
complete edentulism.
▸Everybody needs teeth to chew, to talk and to
Smile Over!
▸Several Dental problems that were previously
deemed difficult are now shaping out to be simple
and effective to perform.
3

INTRODUCTION
THE NEED
▸Patients with missing
posterior teeth often are
given choices to restore the
area with fixed wast partial
dentures or even a distal
extension removable partial
denture.
▸Trauma victims missing one
or several teeth are offered
Crowns and Bridges as
alternatives.
4

INTRODUCTION
▸Dental Professionals did not have positive
opinions for Dental Implants in the first few
years.
▸No scientific research
▸No Clinical experience
▸No major understanding
5

EVIDENCE BASED
IMPLANT DENTISTRY
TURNING
POINT
6

INTRODUCTION
OSSEOINTEGRATION
▸The term refers to the integration of the Implant Interface to the
bone.
▸By a Histologic Definition, Osseointegration means "a direct
connection between living bone and load-bearing endosseous
implant at the light microscopic level. "
▸Initially introduced by Prof.P.I.Branemark and his Swedish team in
the early 1980s.
▸Basically to use the alveolar bone as a support in order to restore
teeth in edentulous areas.
▸Several factors contribute to remarkably high success rates in
Dental Implants.
7

IMPLANT SUCCESS
GENERALLY ACCEPTED
IMPLANT SUCCESS CRITERIA
▸The individual Implant is immobile when tested clinically.
▸No evidence of peri-implant radiolucency is present, as assessed
on an undistorted radiograph.
▸The mean vertical bone loss is less than 0.2mm annually after
being loaded for a duration of 1 year.
▸No persistent pain/ discomfort or infection is attributable to the
Implant.
Criteria for success for osseointegrated endosseous implants, J Prosthet Dent 62: 567, 1 989.
8

UNDERSTANDING BONE
FOR IMPLANT THERAPY
Anatomic Considerations
9

ANATOMIC CONSIDERATIONS
MAXILLA
▸Osseous foundation
provided by the paired
Maxillae and the
zygomatic bones.
▸Also constituted by the
Palatine bones, Vomer,
Maxillary Sinus.
▸Masticatory forces and
Buttresses along the
planes of the bone.
1
0

MAXILLA
▸Maxillary posterior teeth
are inclined buccally 5-
10 degrees opposite to
the mandibular teeth
(Inclined lingually)
▸This curve is also called
as the ‘Curve of Wilson’.
▸Special consideration
while placing maxillary
implants.
1
1

ANATOMICAL CONSIDERATIONS
MAXILLA
▸Mastication allows for
osteogenic stimulation to the
maxillary alveolus.
▸Labial plate receives minimal
tensile forces
▸Note: Entire maxillary arch is
composed of cancellous or
spongy bone.
▸In addition, the presence of
the Maxillary Sinus.
1
2

MANDIBLE
▸Loss of teeth in the mandibular
arch causes alveolar resorption
in a dramatic pattern.
▸Altering mandibular morphology
and relationships of vital
structures within the bone and
the soft tissues enveloping the
bone.
▸Goal of Implants in Mandible:
To utilize existing morphology
without altering bone and to
provide solutions that can be
effectively maintained.
1
4

MANDIBLE
▸Additional Procedures:
▸Inferior alveolar canal re-positioning
▸Re Contouring the symphysis region.
▸Alveoloplasty
▸Detachment of Genial Tubercles and
muscles involved.
1
6

Biological process of implant
osseointegration
The healing process of
implant system is similar to
primary bone healing.
Titanium dental implants
show three stages of
healing.

CRITICAL POINTS
BIOLOGICAL CONSIDERATIONS
FOR OSSEOINTEGRATION
▸Four main factors are required to achieve optimal and
successful osseo-integrated bone-to-implant interface.
▸A Biocompatible Material
▸An Implant that is precisely adapted to the prepared bony
site.
▸Atraumatic surgery to minimize tissue damage
▸An Immobile, undisturbed healing phase.
1
9

UNDERSTANDING
THE SOFT TISSUE
TO IMPLANT
INTERFACE
THINGS TO KNOW
2
0

SOFT TISSUES AND THE
IMPLANT
▸Dental Implants should always have unbroken,
peri-mucosal seal between the soft tissue and the
Implant abutment surface.
▸High levels of Oral Hygiene are of prime
importance in the success of Dental Implants.
▸Establish a comprehensive ‘Implant Maintenance
Program’ and regular scheduled recall visits.
▸Soft tissues always follow the framework of the
alveolar bone below.
2
1

BONE IN
IMPLANT
DENTISTRY
CRITICAL EVALUATION
2
2

UNDERSTANDING BONE
BONE AND BONE DENSITY: KEYS
TO SUCCESSFUL IMPLANT
PRACTICE
▸Internal structure of bone is described in terms of Quality/ Density
▸Strength
▸Modulus of Elasticity
▸Bio-mechanical properties
▸Implant design
▸Implant shape
▸Surgical approaches
▸Healing
▸Progressive loading
2
3

SURGICAL APPROACHES
D1
D2
D3
D4

BONE DENSITY
▸Decreases after tooth loss
▸Remodelling
▸Misch Bone Density Classification:
2
5

UNDERSTANDING BONE DENSITY
D1 BONE
▸Comprised of dense cortical bone.
▸Highly mineralised
▸Withstands high occlusal loads
▸Found in Mandibular anterior regions
▸Has the greatest Bone-Implant Contact.
▸Best for Short Length Implants
▸But, fewer blood vessels, hence dependant on the periosteum for
nutrition and survival.
▸Difficult to prepare the Implant Osteotomy site owing to its cortical
component.
▸Invariably the apical portion of the osteotomy site receives maximum heat
during procedure making the region susceptible to thermal trauma.
2
6

D2 BONE
▸Combination of Dense-to-porous cortical
bone on the crest and coarse trabecular
bone on the inside.
▸40% stronger than D3 bone.
▸Predictable Osseointegration, hence most
preferred type.
▸Intra-bony vascular supply aids in healing
and reducing thermal trauma.
2
7

D3 BONE
▸Comprised of thinner porous cortical bone on the crest and fine
trabecular pattern within the ridge.
▸Found most often in anterior maxilla and posterior regions of the jaws.
▸Reduced Bone-Implant Contact due to porous nature.
▸Risk of Implant Failure
▸Increasing the diameter of implants in D3 bone improves the prognosis of
the Implants Success rate.
▸Reduced time in preparing Osteotomy site.
▸Owing to its softness, perforations may occur due to improper
angulations.
▸Delicate to manage this type of bone.
2
8

D4 BONE
▸Fine trabecular pattern of bone with least density and little or no cortical
component.
▸Completely opposite to the D1 type of bone.
▸Seen in Posterior molar region of maxilla in a long term edentulous
patient.
▸No cortical crest
▸Decreased height of bone, width and length of osteotomy site.
▸Reduced Bone-Implant Contact area
▸Coated implants aid to some extent in osseointegration and prove better
results.
2
9

BONE ASSESSMENT
MEASUREMENTS
▸Height of available bone is measured from the crest
of the edentulous ridge to the opposing landmark.
▸Anterior aspects of the jaws show more available
bone height when compared to that available in the
posterior region.
▸Width of the bone is measured between the facial
and lingual plates to determine the implant platform
diameter.
3
0

AS A GENERAL RULE,
AN IMPLANT SHOULD
BE AT LEAST 2 MM
AWAY FROM AN
ADJACENT TOOTH
AND 3MM AWAY
FROM AN ADJACENT
IMPLANT
3
1

BONE MEASUREMENTS
ANGULATION
▸This is as important as the height, width
and inter-implant distance.
▸Represents the natural tooth trajectory.
▸Ideally, perpendicular to the occlusion.
▸For Eg.: Maxillary Implants need to be
angulated labially and Mandibular
Implants lingually, to maintain natural and
the Curve of Spee (Post Insertion)
3
2

BONE MEASUREMENTS
CROWN HEIGHT SPACE
▸Absolutely Important prior to placing an
Implant.
▸Vertical distance between the crest of the
ridge to the occlusal plane of that jaw.
▸Affects the final appearance of the
prosthesis.
▸Ideally, this space should be equal to or
less than 15mm.
3
3

UNDERSTANDING RESULTS
IN SHORT
▸ Prosthesis should be designed at the
onset of treatment.
▸ Choice of bone available should be
assessed prior to finalising Implant
dimensions.
▸ Place Implants in Good Quality Bone.
▸ Allow for additional procedures where
required to support the Implant.
▸ Where no ideal situations favour Implant
therapy, provide an alternate option
rather than try to satisfy patients
expectations of a fixed prosthesis
knowing that conditions are not ideal.
3
4

STEP 1: INITIAL SURGERY
STEP 2: OSSEOINTEGRATION PERIOD
STEP 3: ABUTMENT CONNECTION
STEP 4: FINAL PROSTHETIC
RESTORATION
SURGICAL PROCEDURE

PATIENT EVALUATION
 Medical history
 vascular disease
 immunodeficiency
 diabetes mellitus
 tobacco use
 bisphosphonate use

HISTORY OF IMPLANT SITE
 Factors regarding loss of tooth being replaced
 When?
 How?
 Why?
 Factors that may affect hard and soft tissues:
 Traumatic injuries
 Failed endodontic procedures
 Periodontal disease
 Clinical exam may identify ridge deficiencies

SURGICAL PHASE- TREATMENT
PLANNING
 Evaluation of Implant Site
 Radiographic Evaluation
 Bone Height, Bone Width and Anatomic
considerations

BASIC PRINCIPLES
 Soft/ hard tissue graft bed
 Existing occlusion/ dentition
 Simultaneous vs. delayed reconstruction

SMILE LINE
 One of the most influencing factors of any
prosthodontic restoration
 If no gingival shows then the soft tissue quality,
quantity and contours are less important
 Patient counseling on treatment expectations is
critical

 Ridge relationship
 Attached tissue
 Interarch clearance
 Inferior alveolar nerve
 Maxillary sinus
 Floor of nose

RADIOLOGICAL/IMAGING STUDIES
 Periapical radiographs
 Panoramic radiograph
 Site specific tomograms
 CAT scan (Denta-scan, cone beam CT)

DENTAL IMPLANT SURGERY PHASE I
 Aseptic technique
 Minimal heat generation
 slow sharp drills
 internal irrigation?
 external cooling

DENTAL IMPLANT SURGERY PHASE I
 Adequate time for integration
 Adequate recipient site
 soft tissue
 bone
 Kind & Gentle technique

Sinus and Inferior
alveolar nerve
MEDICAL
CONDITION
Reduced
interocclusion
clearance
QUALITY &
QUANTITY OF
BONE
CHALLENGE TO IMPLANT

BoynePJ,JamesRA.Grafting ofthe maxillary sinus floor with autogenous marrow and
bone. J Oral Surg. 1980;38:613616.
History
The sinus floor augmentation technique was first
presented by Boyne and James it was based on the
lateral window method that was a modification of the
known sinus revision procedure according to Caldwell-
Luc.

Tatum H. Maxillary and sinus implant recon-structions. Dent Clin North Am
1986;30: 207–29
The sinus lifting technique described by Tatum in 1986 is a
documented method reported in the literature for the
functional rehabilitation of patients with severe maxillary
atrophy

•Known as ANTRUM OF HIGHMORE (1651)
•The largest of the Paranasal Sinus
•Is a large pyramidal cavity with in body of maxilla.
DIMENSION & EPITHELIUM
Height : 33 mm
Width : 23 mm
Anteroposterior : 34 mm
Volume : 15 ml (approx)
Epithelium :Ciliated Pseudostratified Collumanar
Epithilium.
Maxillary Sinus

DEFINITION
The maxillary sinus is the pneumatic space that is
lodged inside the body of maxilla and that
communicates with the environment by the way of
middle meatus and nasal vestibule

AGE CHANGES
1st year Lateral expansion and extend beneath infraorbital canal.
20th month Posteriorly; position of rudimentary 1st permanent first molar
2nd year Half the adult size.
3rd and 4th year Growth in width ; related to deciduous 2nd molar and crypt of
1st molar accompanied by resorbtion of internal surfaces
except medial wall.
7th year Height 17mm; AP length 27mm; Width 18mm.
12th year Surgically accessible through inferior meatus of nose.
Adult Height 35mm ; AP length 32mm; Width 25mm.

Growth of the maxillary
sinus from birth to
Adulthood

SCHNEIDERIAN MEMBRANE
• Maxillary sinus is lined with a respiratory mucosa
• Lining is a Mucoperiosteum
1.Epithelial covering
2.Lamina propria
3.The periosteum
• The thickness of the combined layers is generally
less than 1 mm

FUNCTION
1.Resonance of voice
2.Humidification
3.Thermostat
4.Cushioning effect for the ORBIT
5.Make the skull lighter

NERVES & VESSELS
Artery : Facial ,Infraorbital and Greater
palatine.
Vein : Facial ,Pterygoid plexus of vein.
Nerves: Infraorbital and Middle ,Anterior ,posterior
branches of maxillary division 5th nerve.
Lymphatic : Submandibular Nodes & Retro pharyngeal
Nodes.

DIGNOSTIC
IMAGING
OF MAXILLARY
SINUS

STANDARD RADIOGRAPHS
1.Intraoral radiographs
2.Plain Films:3 standard views
Caldwell.
Waters
Lateral
3.Panoramic Radiography:

CROSS SECTIONAL IMAGING
1. CT
2. Three-dimentional CT
3. Dentascan
4. MR Imaging

SURGICAL ANATOMY
Opening of sinus with oral cavity may occur if the roots
of maxillary molar extends into the sinus(Oroantral
fistula).
Cald well-luc procedure is the commonest surgery which
involves in opening of the sinus in canine fossa.

SINUS LIFT PROCEDURE
Indications:
•Pnuematization of maxillary sinus in old age
•Atrophy of the ridge
•Sinus floor is lowered in posterior maxillary region
•To improve the implant support
The sinus lining at the floor is lifted up surgically & bone
graft is placed between sinus lining and inner aspect of
alveolar crest.

SINUS LIFT PROCEDURE
 There are two main approches for lifting the maxillary
sinus:
Direct
(Caldwell Luc)
Indirect
(Osteotome)

SINUS AUGMENTATION
Augmentation can be achieved either by placing material
in direct contact with the membrane or by creating a new
cavity using a sinus partitioning technique.
Which is recommended for the creation of a stable site
,augmented with autologous bone harvested from an
extra or intraoral site.

INSTRUMENTS USED FOR DIRECT SINUS LIFT

BONE GRAFTING OF SINUS & DELAYED PLACEMENT OF
ENDOSTEAL IMPLANTS
Indicated when at least 5 mm of vertical bone &
sufficient width are present between sinus floor & crest
of alveolar ridge.
A Tatum lateral maxillary wall approach is performed just
superior to residual alveolar bone. Lateral access window &
membrane are rotated in & upward,a bone graft is placed.

SINUS LIFT AND GRAFT SURGERY
Floor of antrum is scratched to induce bleeding & permit
blood vessels to enter graft from below. Autogenous
bone is placed in bottom of graft in area of future
implant placement.

SINUS LIFT AND GRAFT SURGERY
After 3-4 months, when area is healed uneventfully, implants
can be inserted.

POST OPERATIVE INSTRUCTIONS:
1. Do not blow nose.
2. Do not smoke.
3. Do not take liquids through straw.
4. Do not lift/pull lip to see stitches.
5. Take medications as directed.
One important post operative complication is membrane
perforation.

DIRECT SINUS LIFT ADVANTAGES
•It is clear
•Easy access
•Loading of the implant can be immediate
•More effective work is done

DISADVANTAGE
•More pain
•More post-operative discomfort
•Time consuming
•Needs highly efficient practitioner
•More susceptible for infection

INDIRECT SINUS LIFT
Osteotome Technique
Invented by Summer in 1994

Punch a hole through where the rectangle was created
into the sinus floor.The sinus is then raised with bone
grafting material and implants are placed.
A sharp osteotome is used to “chisel” a rectangle
in the crestal ridge of the maxilla ,then a sinus-
lift osteotome is used like a mallet to fracture
the bone
A crestal incision is made ,and the crestal
ridge is exposed

INSTRUMENTS USED FOR IN DIRECT SINUS
LIFT

•Less invasive
•Shorter healing and waiting period
•<10mm >7mm
•Increasing vertical height of the bone upto 4mm
•Sinus is approached from crest of the alveolar ridge
and an osteotome is used.

U shaped osteotomy of the maxillary sinus
Swinging the partially freed-up bone segment cranialy into
the maxillary sinus.
Created space is filled with bone graft
Implant is palced after 6 months

Implant osteotomy is performed 1 to 2 mm below the floor
of the sinus.
A flat end osteotome is inserted and firmly tapped in to
position 1 -2 mm short of floor of sinus.
A green stick fracture of the sinus floor elevates bone and
sinus membrane over broad based flat ended osteotome.
The final implant is then inserted in the implant osteotomy.
Elevation of sinus results in formation of new bone.
If sinus membrane perforation occurs bone formation is
rare.

Floor of the sinus rests on apex of implant which is
nearly 4 mm above original floor position .

INDIRECT SINUS LIFT ,ADVANTAGES:
Minimally invasive surgical procedure.
The osteotomy is minimal being 1-3mm deep and wide.
Minimal instrumentation with closed graft deliver
permits a sterile technique.
Simplicity of the procedure requires less time and
expertise.

INDIRECT SINUS LIFT ,DISADVANTAGES
Immediate implant loading is recommended after 3
months.
Blind procedure (the sinus isn’t exposed).
More chance of errors to occur.

CONTRAINDICATIONS
•Sinus infection
•Tumors or pathologic groth in sinus
•Severe allergic rhinitis
•Chronic topical steroid use
•Radiation therapy
•Excessive tobacco use
•Psychologic / mental impairment

 Accidents are events that occur during surgery Accidents
always happen during surgical procedures.
 Complications appear lately, once surgery is already
performed. There are two kinds of complications,
depending on the time they emerge: early and late.
Early-stage complications appear in the immediate
postoperative period and interfere with healing,
Late-stage complications arise during the process of
osseointegration.

 Failures occur when the professional and/or the
patient do not obtain the desirable results
 Iatrogenic acts are regarded as accidents,
complications or failures caused by a deficient
praxis of the professional
(Annibali et al, 2009)

CLASSIFICATION (CARRANZA)
Surgical complications
Biologic complications
Technical or mechanical complications
Esthetic and phonetic complications

BLEEDING
 Common accident as a consequence of local-anatomical or
systemic causes.
Causes of bleeding:
lesions in any sublingual, lingual, perimandibular,
or submaxillary artery
Surgeries in the lower and anterior area of totally edentulous
patients who have a deficit in the quality and quantity of bone.

Treatment: local intraoperative or postoperative measures
 Local hemostasis :
Suture
compression,
the use of hemostatic microfibrilar
collagen gauzes,
oxidized cellulose,
reabsorbable fibrin,
mouth rinsing with 4.8% of tranexamic
acid

 Swelling - more noticeable 24 hours after performing surgery
 Causes:
 Wide flaps,
 Bone regenerating techniques, and
 surgery time
Edema

HEMORRHAGE/ ECCHYMOSIS
 Severe bleeding and the formation of massive
hematomas in the floor of the mouth are the result of
an arterial trauma.
Several types of hemorrhagic patches can develop as a
result of injury:
Petechiae (<2 mm in diameter),
Purpura (2 to 10 mm), and
Ecchymosis (>10 mm).

Ecchymosis are the result of an intermental surgery
procedure.


 Swelling and elevation of floor of the mouth
 Increase in tongue size
 Difficulty in swallowing or speech
 Pulsating or profuse bleeding from the floor of the mouth
or the osteotomy site

Bleeding site during
implant osteotomy
Arteries Treatments
Posterior mandible Mylohyoid Finger pressure at the
site
Middle lingual of
mandible
Submental Surgical ligation of facial
and lingual
arteries
Anterior lingual of
mandible
Terminal branch of
sublingual or submental
Compression,
vasoconstriction,
cauterization, or ligation
Invading the mandibular
canal
Inferior alveolar artery Bone graft
Treatment of a hemorrhage at an implant osteotomy site (Park &
Wang, 2005)

NEUROSENSORY
DISTURBANCES
 Nerve lesions are both an intraoperative accident and a
postoperative complication that can affect the infra-orbital
nerve, the inferior alveolar nerve, or its mental branch and
the lingual nerve.
 These complications have a low incidence (reported
between 0%-44%)

Several implants in contact to the Inferior
Alveolar nerve in patients with postoperative
paresthesia.

CAUSES
 INDIRECT
Postsurgical intra-alveolar edema or hematomas- produce a
temporary pressure increase, especially inside the mandibular
canal
 DIRECT
Compression, stretch, cut, overheating, and accidental
puncture
(Annibali et al., 2009)

 Poor flap design,
 Traumatic flap reflection,
 Accidental intraneural injection,
 Traction on the mental nerve in an elevated flap,
 Penetration of the osteotomy preparation
 Compression of the implant body into the canal
(Misch & Wang, 2008).

The nerve injury may cause one of the following conditions:
 Parasthesia (numb feeling),
 Hypoesthesia (reduced feeling), hyperesthesia
(increased sensitivity),
 Dysthesia (painful sensation), or
 Anesthesia (complete loss of feeling) of the teeth, the lower
lip, or the surrounding skin and mucosa
(Greenstein & Tarnow, 2006 as cited in Sharawy & Misch,
1999).

TREATMENT (MISCH & RESNIK, 2010).
 Too much proximity between the implant and a nerve-
removal as soon as possible
 Treatment with corticosteroids and non-steroidal anti-
inflammatory drugs - to control inflammatory reactions that
provoke nervous compression.
 Topical application of dexamethasone (4 mg/ml) for 1 or 2
minutes enhances recovery,
 Oral administration (high doses)- within one week of injury-
prevention of neuroma formation

 Intraoperative nerve section - microsurgery
techniques to reestablish nerve continuity.
 Neurosensorial loss - checked at different moments to
determine with precision the evolution of the lesion
 Resort to microsurgery if, after four months -
patient’s situation has not improved, pain persists
and there is a remarkable loss of sensitivity.

MALPOSITION OR ANGULATION OF AN
IMPLANT
 The definition of a ‘malpositioned implant’ is an implant
placed in a position that created restorative and
biomechanical challenges for an optimal result.
most common - deficiency of the osseous housing around the
proposed implant site.
Bone resorption :
osseous remodeling following tooth loss,
osteoporosis, etc.


Use of repositioning system.
Improves esthetic effects, the biomechanical
behavior of the implant

:
 Assess the characteristics of the edentulous zone
subject to rehabilitation using clinical and
radiological CT, or cone beam CT imaging
(Dreiseidler et al., 2009)

 Use short or tilted implants (aproximately 30º) or”
 avoid anatomical structures (mental nerve, maxillary
sinus).

IMPROPER IMPLANT
LOCATION/IMPLANT DISPLACEMENT
(a) Implant installed . (b) Control CT Scan after
displacement and before second stage surgery. (c)
Change of position.

MANDIBULAR FRACTURE
Perforation of the lingual cortical
during drilling.
Infrequent complication

IMPLANT EXPOSURE
 Can be associated with exudate and bone loss

:
 Complete exposure of the implant cover screw
 Removal of the healing cover
 Flushing of the implant with chlorhexidine, insertion
of a gingival former
 Oral hygiene with soft toothbrush
 Chlorhexidine application over the area twice each day


 Gingival Former, tissue approximated
 Membrane can be used
 Antibiotics and chlorhexidine daily rinses

 Uncovering of implant, removal of cover screw
 Curetting of granulation tissue
 Cleaning of implant surface-diamond bur/ air abrasive
 Bone grafts and membrane

IMPLANT FRACTURE
 Infrequent complication (among 0,2 y- 1.5% of cases )
(Eckert et al., 2000)
 Complications is higher in implants supporting fixed partial
prosthesis than in complete edentulous patients.
 Causes:
Defects in the implant design or materials used in their
construction,
A non-passive union between the implant and the prosthesis or
by mechanical overload,

Management:
Removal of the implant and its replacement by another one
(a) Implant
fractured in
maxillary
posterior region.
(b) Implants retrieved. (c) Substitution for a
wider diameter in the
same surgery

INFECTIONS
PERIIMPLANTITIS
PERIIMPLANT
MUCOSITIS
HYPERPLASTIC
MUCOSITIS
FISTULATIONS
MUCOSAL
ABSCESS

• History of periodontitis
• Smoking
• Poor oral hygiene
• Exposed threads
• Exposed surface coatings (roughened surfaces)
• Deep pockets (placed too deep, placed into
deficiencies)
• No plaque removal access (ridge lap crown,
connected prostheses)
Risk factors for peri-implantitis

Surgical approach:
1.
 using abundant saline rinses at the defect,
 barrier membranes,
 close flap adaptation and
 careful post-surgical monitoring for several months.
 Plaque control is to be assured by applying chlorhexidine
gels.
2.
 Apical repositioning of the flap following osteoplasty
around the defect.

CONCLUSION
Dental implant placement is not free of complications, as
complications may occur at any stage.
Careful analysis via imaging, precise surgical techniques and an
understanding of the anatomy of the surgical area are essential in
preventing complications.
Prompt recognition of a developing problem and proper
management are needed to minimize postoperative
complications.

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